When you think about the last time you gave someone a gift, what feelings do you remember? Maybe it was for a holiday, or a birthday, or just a no-reason way of showing appreciation to someone you care about. For me, it was my dad’s birthday, late last month. There is always a bit of trepidation and uncertainty around whether or not the gift will be useful to the recipient, or if they even like it. And while you’re giving this gift without really expecting anything in return, there is always an expectation, or at least a hope, that the recipient will show their gratitude. After all, you’re doing something nice for them!
Receiving a present is also tricky. I always feel nervous about whether or not I will like the gift, or if it will end up sitting unused, collecting dust. But regardless of whether we like the present or not, we feel an obligation to show our thankfulness in an authentic way, to show that this expense taken on our behalf was not done without reason.
Gift-giving thus becomes its own kind of awkward social dance. So how does this look on a widespread scale – even globally? This was one of the topics that Dr. Holman and I explored in our discussion on Friday. Last week, I finished reading her book Beholden: Religion, Global Health, and Human Rights. The final chapter is on the concept of the gift, and what gift-giving might look like in global health contexts.
A gift is different from charity. Charity, while not all bad, implies some patronization and an attitude of “helping” those who are helpless. Gift-giving emphasizes the fact that everyone has something to offer. In gift-giving, while the giver still does not expect anything in return from the recipient, they also look out for ways that they can learn from the recipient. It places both the giver and recipient on equal footing. For gift-giving, picture an image of two people walking alongside each other, learning from each other. Charity would be more like the image of one person deigning to lean down and pull up the other.
While gift-giving is a sort of exchange, the people involved still do not have any expectation of being “repaid.” It is a tricky balance, and requires both vulnerability and an unwavering focus on the dignity of all people.
This week, I also read some selected chapters from an anthology book honoring the late Dr. Paul Farmer, a pioneer in global health. Dr Farmer established multiple hospitals in low-income nations, giving care and training to new generations of local doctors. He also challenged notions about what global health interventions were possible, often seeking after the seemingly lost-cause cases.
One chapter in this book, “Liberating Theological Ethics from the Invisible Hand,” discussed how the economic principles of neoliberalism have seeped into global health. This process has made patients “consumers” and services “products.” In our market-infused health system, nothing is given without something else being expected in return. “Cost-effectiveness” and “efficiency” are the gold standard, prioritized above impact on human health and wellbeing. If money is being invested into a project, that project better have some sort of financial benefit to show for it.
Gift-giving is a way to challenge this market-driven approach to health. Profit is not the ultimate goal, but the wellbeing of each person, no matter how disadvantaged, is.
Most importantly, this gift exchange goes both ways. As Christians, we are reminded of the ultimate, selfless gift of grace and how there is nothing that we, as humans, can do to “repay” or reciprocate that gift. This gift-exchange mindset means being willing to give what you are able without a sense of being owed something in return. It also means being open to receiving gifts ourselves without feeling a need to repay it, as we have received grace. Gift-giving in global health means that our main goal is to emphasize the dignity of each person as a child of God, instead of as a potential revenue source. This might look like providing services without any requirement of payment from patients. Or it could look like walking 6 hours to make a home visit, as Dr. Farmer often did.
This is a wonderful ideal to aspire to. But most of us are not charismatic, trained medical doctors who can pause our lives to start building a hospital in Haiti. Still, there is need everywhere, and it is oftentimes right on our doorstep. My work this summer, at Bread for the City and Catholic Charities of D.C, has been centered around this type of gift-giving. Both organizations provide free health and social services to the community – work that isn’t very “cost-effective” or “profit-driven.” It is easy to slip into a mentality of “helping” our disadvantaged “consumers.” But as I’ve found through experience, this closes the door on seeing the whole person with whom I am interacting. It both closes the door on learning anything from them, and makes me more impatient.
When we feel as though we have nothing to give, or don’t know what to give, a listening ear and some time is all we need. A later chapter in the Paul Farmer book, “Practicing Local Listening with Village Midwives in Sudan,” highlights the title’s case study. Truly listening to what people have to say about their lived experiences – and not just hearing what we want to hear! – is the mark of a mutual gift giving. It reflects a just and fair community partnership, in which services and knowledge are given freely, and all community members walk together in solidarity on the road to better health.
This is one in a series of post by Elizabeth Rambo, on her 2024 PLT summer internship experience.
Readings:
Clark, M. (2023). Practicing local listening with village midwives in Sudan: A case study for theological ethics. In J.W. Block, M.T. Lysaught, and A.A. Martins (eds.), AA Prophet to the Peoples: Paul Farmer’s witness and theological ethics. Pickwick Publications.
Holman, S.R. (2015). Beholden: Religion, global health, and human rights. Oxford University Press.
Lysaught, M. (2023). Liberating theological ethics from the invisible hand: Paul Farmer, the world’s poor, and the quandaries of the fortunate. In J.W. Block, M.T. Lysaught, and A.A. Martins (eds.), A Prophet to the Peoples: Paul Farmer’s witness and theological ethics. Pickwick Publications.
The Project on Lived Theology at the University of Virginia is a research initiative, whose mission is to study the social consequences of theological ideas for the sake of a more just and compassionate world.